Observation of Axisymmetric Standard Magnetorotational Instability in the Laboratory.

We report the first direct evidence for the axisymmetric standard magnetorotational instability (SMRI) from a combined experimental and numerical study of a magnetized liquid-metal shear flow in a Taylor-Couette cell with independently rotating and electrically conducting end caps. When a uniform vertical magnetic field B_{i} is applied along the rotation axis, the measured radial magnetic field B_{r} on the inner cylinder increases linearly with a small magnetic Reynolds number Rm due to the magnetization of the residue Ekman circulation. Onset of the axisymmetric SMRI is identified from the nonlinear increase of B_{r} beyond a critical Rm in both experiments and nonlinear numerical simulations. The axisymmetric SMRI exists only at sufficiently large Rm and intermediate B_{i}, a feature consistent with theoretical predictions. Our simulations further show that the axisymmetric SMRI causes the velocity and magnetic fields to contribute an outward flux of axial angular momentum in the bulk region, just as it should in accretion disks.

Low Income and Nonwhite Race are Strongly Associated with Worse Quality of Life in Patients with Nephrolithiasis.

PURPOSE: Kidney stones are a source of significant morbidity which have been shown to negatively impact health related quality of life. We sought to understand the association between health related quality of life, socioeconomic status and race among patients with kidney stones. MATERIALS AND METHODS: Patients with stones at a total of 11 stone centers across the United States completed the WISQOL (Wisconsin Stone Quality of Life questionnaire). The patient ZIP Code™ was used to estimate household income. A mixed effects regression model was constructed for analysis with ZIP Code as the random intercept. RESULTS: A total of 2,057 stone formers completed the WISQOL. Lower income was independently associated with significantly lower health related quality of life (ß = 0.372, p = 0.014), as were nonwhite race (ß = -0.299, p = 0.001), unemployed work status (ß = -0.291, p = 0.008), female gender (ß = -0.204, p <0.001), body mass index greater than 40 kg/m2 (ß = -0.380, p <0.001), 5 or more medical comorbidities (ß = -0.354, p = 0.001), severe recurrent stone formation (ß = -0.146, p = 0.045), enrollment at an acute care visit, or a preoperative or postoperative appointment (ß = -0.548, p <0.001) and recent stone symptoms (ß = -0.892, p <0.001). CONCLUSIONS: Lower income, nonwhite race and unemployed work status were independently associated with lower health related quality of life among patients with kidney stones. While clinical characteristics such as body mass and stone disease severity were also associated with health related quality of life, this study shows that socioeconomic factors are similarly important. Further research to understand the specific mechanisms by which socioeconomic status and race impact health may lend insight into methods to optimize clinical treatment of stone formers and patients with other chronic diseases.

Preoperative arterial microcalcification and clinical outcomes of arteriovenous fistulas for hemodialysis.

BACKGROUND: Arteriovenous fistulas (AVFs) often fail to mature, but the mechanism of AVF nonmaturation is poorly understood. Arterial microcalcification is common in patients with chronic kidney disease (CKD) and may limit vascular dilatation, thereby contributing to early postoperative juxta-anastomotic AVF stenosis and impaired AVF maturation. This study evaluated whether preexisting arterial microcalcification adversely affects AVF outcomes. STUDY DESIGN: Prospective study. SETTING & PARTICIPANTS: 127 patients with CKD undergoing AVF surgery at a large academic medical center. PREDICTORS: Preexisting arterial microcalcification (≥1% of media area) assessed independently by von Kossa stains of arterial specimens obtained during AVF surgery and by preoperative ultrasound. OUTCOMES: Juxta-anastomotic AVF stenosis (ascertained by ultrasound obtained 4-6 weeks postoperatively), AVF nonmaturation (inability to cannulate with 2 needles with dialysis blood flow ≥ 300mL/min for ≥6 sessions in 1 month within 6 months of AVF creation), and duration of primary unassisted AVF survival after successful use (time to first intervention). RESULTS: Arterial microcalcification was present by histologic evaluation in 40% of patients undergoing AVF surgery. The frequency of a postoperative juxta-anastomotic AVF stenosis was similar in patients with or without preexisting arterial microcalcification (32% vs 42%; OR, 0.65; 95% CI, 0.28-1.52; P=0.3). AVF nonmaturation was observed in 29%, 33%, 33%, and 33% of patients with <1%, 1% to 4.9%, 5% to 9.9%, and ≥10% arterial microcalcification, respectively (P=0.9). Sonographic arterial microcalcification was found in 39% of patients and was associated with histologic calcification (P=0.001), but did not predict AVF nonmaturation. Finally, among AVFs that matured, unassisted AVF maturation (time to first intervention) was similar for patients with and without preexisting arterial microcalcification (HR, 0.64; 95% CI, 0.35-1.21; P=0.2). LIMITATIONS: Single-center study. CONCLUSIONS: Arterial microcalcification is common in patients with advanced CKD, but does not explain postoperative AVF stenosis, AVF nonmaturation, or AVF failure after successful cannulation.

Correlation of pre-existing vascular pathology with arteriovenous graft outcomes in hemodialysis patients.

BACKGROUND: Arteriovenous grafts (AVGs) are prone to neointimal hyperplasia leading to AVG failure. We hypothesized that pre-existing pathologic abnormalities of the vessels used to create AVGs (including venous intimal hyperplasia, arterial intimal hyperplasia, arterial medial fibrosis, and arterial calcification) are associated with inferior AVG survival. STUDY DESIGN: Prospective observational study. SETTING & PARTICIPANTS: Patients with chronic kidney disease undergoing placement of a new AVG at a large medical center who had vascular specimens obtained at the time of surgery (n = 76). PREDICTOR: Maximal intimal thickness of the arterial and venous intima, arterial medial fibrosis, and arterial medial calcification. OUTCOME & MEASUREMENTS: Unassisted primary AVG survival (time to first intervention) and frequency of AVG interventions. RESULTS: 55 patients (72%) underwent interventions and 148 graft interventions occurred during 89.9 years of follow-up (1.65 interventions per graft-year). Unassisted primary AVG survival was not associated significantly with arterial intimal thickness (HR, 0.72; 95% CI, 0.40-1.27; P = 0.3), venous intimal thickness (HR, 0.64; 95% CI, 0.37-1.10; P = 0.1), severe arterial medial fibrosis (HR, 0.58; 95% CI, 0.32-1.06; P = 0.6), or severe arterial calcification (HR, 0.68; 95% CI, 0.37-1.31; P = 0.3). The frequency of AVG interventions per year was associated inversely with arterial intimal thickness (relative risk [RR], 1.99; 95% CI, 1.16-3.42; P < 0.001 for thickness <10 vs. >25 µm), venous intimal thickness (RR, 2.11; 95% CI, 1.39-3.20; P < 0.001 for thickness <5 vs. >10 µm), arterial medial fibrosis (RR, 3.17; 95% CI, 1.96-5.13; P < 0.001 for fibrosis <70% vs. ≥70%), and arterial calcification (RR, 2.12; 95% CI, 1.31-3.43; P = 0.001 for <10% vs. ≥10% calcification). LIMITATIONS: Single-center study. Study may be underpowered to demonstrate differences in unassisted primary AVG survival. CONCLUSIONS: Pre-existing vascular pathologic abnormalities in patients with chronic kidney disease may not be associated significantly with unassisted primary AVG survival. However, vascular intimal hyperplasia, arterial medial fibrosis, and arterial calcification may be associated with a decreased frequency of AVG interventions.

Delayed administration of a small molecule tropomyosin-related kinase B ligand promotes recovery after hypoxic-ischemic stroke.

BACKGROUND AND PURPOSE: Stroke is the leading cause of long-term disability in the United States, yet no drugs are available that are proven to improve recovery. Brain-derived neurotrophic factor stimulates neurogenesis and plasticity, processes that are implicated in stroke recovery. It binds to both the tropomyosin-related kinase B and p75 neurotrophin receptors. However, brain-derived neurotrophic factor is not a feasible therapeutic agent, and no small molecule exists that can reproduce its binding to both receptors. We tested the hypothesis that a small molecule (LM22A-4) that selectively targets tropomyosin-related kinase B would promote neurogenesis and functional recovery after stroke. METHODS: Four-month-old mice were trained on motor tasks before stroke. After stroke, functional test results were used to randomize mice into 2 equally, and severely, impaired groups. Beginning 3 days after stroke, mice received LM22A-4 or saline vehicle daily for 10 weeks. RESULTS: LM22A-4 treatment significantly improved limb swing speed and accelerated the return to normal gait accuracy after stroke. LM22A-4 treatment also doubled both the number of new mature neurons and immature neurons adjacent to the stroke. Drug-induced differences were not observed in angiogenesis, dendritic arborization, axonal sprouting, glial scar formation, or neuroinflammation. CONCLUSIONS: A small molecule agonist of tropomyosin-related kinase B improves functional recovery from stroke and increases neurogenesis when administered beginning 3 days after stroke. These findings provide proof-of-concept that targeting of tropomyosin-related kinase B alone is capable of promoting one or more mechanisms relevant to stroke recovery. LM22A-4 or its derivatives might therefore serve as "pro-recovery" therapeutic agents for stroke.

Observation of a free-Shercliff-layer instability in cylindrical geometry.

We report on observations of a free-Shercliff-layer instability in a Taylor-Couette experiment using a liquid metal over a wide range of Reynolds numbers, Re∼10(3)-10(6). The free Shercliff layer is formed by imposing a sufficiently strong axial magnetic field across a pair of differentially rotating axial end cap rings. This layer is destabilized by a hydrodynamic Kelvin-Helmholtz-type instability, characterized by velocity fluctuations in the r-θ plane. The instability appears with an Elsasser number above unity, and saturates with an azimuthal mode number m which increases with the Elsasser number. Measurements of the structure agree well with 2D global linear mode analyses and 3D global nonlinear simulations. These observations have implications for a range of rotating MHD systems in which similar shear layers may be produced.

Hydrodynamic turbulence cannot transport angular momentum effectively in astrophysical disks.

The most efficient energy sources known in the Universe are accretion disks. Those around black holes convert 5-40 per cent of rest-mass energy to radiation. Like water circling a drain, inflowing mass must lose angular momentum, presumably by vigorous turbulence in disks, which are essentially inviscid. The origin of the turbulence is unclear. Hot disks of electrically conducting plasma can become turbulent by way of the linear magnetorotational instability. Cool disks, such as the planet-forming disks of protostars, may be too poorly ionized for the magnetorotational instability to occur, and therefore essentially unmagnetized and linearly stable. Nonlinear hydrodynamic instability often occurs in linearly stable flows (for example, pipe flows) at sufficiently large Reynolds numbers. Although planet-forming disks have extreme Reynolds numbers, keplerian rotation enhances their linear hydrodynamic stability, so the question of whether they can be turbulent and thereby transport angular momentum effectively is controversial. Here we report a laboratory experiment, demonstrating that non-magnetic quasi-keplerian flows at Reynolds numbers up to millions are essentially steady. Scaled to accretion disks, rates of angular momentum transport lie far below astrophysical requirements. By ruling out purely hydrodynamic turbulence, our results indirectly support the magnetorotational instability as the likely cause of turbulence, even in cool disks.

Identification of a non-axisymmetric mode in laboratory experiments searching for standard magnetorotational instability.

The standard magnetorotational instability (SMRI) is a promising mechanism for turbulence and rapid accretion in astrophysical disks. It is a magnetohydrodynamic (MHD) instability that destabilizes otherwise hydrodynamically stable disk flow. Due to its microscopic nature at astronomical distances and stringent requirements in laboratory experiments, SMRI has remained unconfirmed since its proposal, despite its astrophysical importance. Here we report a nonaxisymmetric MHD instability in a modified Taylor-Couette experiment. To search for SMRI, a uniform magnetic field is imposed along the rotation axis of a swirling liquid-metal flow. The instability initially grows exponentially, becoming prominent only for sufficient flow shear and moderate magnetic field. These conditions for instability are qualitatively consistent with SMRI, but at magnetic Reynolds numbers below the predictions of linear analyses with periodic axial boundaries. Three-dimensional numerical simulations, however, reproduce the observed instability, indicating that it grows linearly from the primary axisymmetric flow modified by the applied magnetic field.

Medial fibrosis, vascular calcification, intimal hyperplasia, and arteriovenous fistula maturation.

BACKGROUND: Arteriovenous fistulas (AVFs) for hemodialysis frequently fail to mature because of inadequate dilation or early stenosis. The pathogenesis of AVF nonmaturation may be related to pre-existing vascular pathologic states: medial fibrosis or microcalcification may limit arterial dilation, and intimal hyperplasia may cause stenosis. STUDY DESIGN: Observational study. SETTING & PARTICIPANTS: Patients with chronic kidney disease (N = 50) undergoing AVF placement. PREDICTORS: Medial fibrosis, microcalcification, and intimal hyperplasia in arteries and veins obtained during AVF creation. OUTCOME & MEASUREMENTS: AVF nonmaturation. RESULTS: AVF nonmaturation occurred in 38% of patients despite attempted salvage procedures. Preoperative arterial diameter was associated with upper-arm AVF maturation (P = 0.007). Medial fibrosis was similar in patients with nonmaturing and mature AVFs (60% ± 14% vs 66% ± 13%; P = 0.2). AVF nonmaturation was not associated with patient age or diabetes, although both variables were associated significantly with severe medial fibrosis. Conversely, AVF nonmaturation was higher in women than men despite similar medial fibrosis in both sexes. Arterial microcalcification (assessed semiquantitatively) tended to be associated with AVF nonmaturation (1.3 ± 0.8 vs 0.9 ± 0.8; P = 0.08). None of the arteries or veins obtained at AVF creation had intimal hyperplasia. However, repeated venous samples obtained in 6 patients during surgical revision of an immature AVF showed venous neointimal hyperplasia. LIMITATIONS: Single-center study. CONCLUSION: Medial fibrosis and microcalcification are frequent in arteries used to create AVFs, but do not explain AVF nonmaturation. Unlike previous studies, intimal hyperplasia was not present at baseline, but developed de novo in nonmaturing AVFs.

Parameter space mapping of the Princeton magnetorotational instability experiment.

Extensive simulations of the Princeton Magnetorotational Instability (MRI) Experiment with the Spectral/Finite Element code for Maxwell and Navier-Stokes Equations (SFEMaNS) have been performed to map the MRI-unstable region as a function of inner cylinder angular velocity and applied vertical magnetic field. The angular velocities of the outer cylinder and the end-cap rings follow the inner cylinder in fixed ratios optimized for MRI. We first confirm the exponential growth of the MRI linear phase using idealized conducting vertical boundaries (end caps) rotating differentially with a Taylor-Couette profile. Subsequently, we run a multitude of simulations to scan the experimental parameter space and find that the normalized volume-averaged mean-square radial magnetic field, our main instability indicator, rises significantly where MRI is expected. At various locations, the local radial components of fluid velocity and generated magnetic field are well correlated with the volume-averaged indicator. Based on this correlation, a diagnostic system that will measure the radial magnetic field at several locations on the inner cylinder is proposed as the main comparison between simulation and experiment. A detailed analysis of poloidal mode structures in the SFEMaNS code indicates that MRI, rather than Ekman circulation or Rayleigh instability, dominates the fluid behavior in the region where MRI is expected.

Ultrasound-guided Morcellation During Difficult Holmium Laser Enucleation of the Prostate.

OBJECTIVE: To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. METHODS: Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. CONCLUSION: This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.

Pancreas surgical complications.

PURPOSE OF REVIEW: Whole organ pancreas transplantation is the most durable cure for type 1 diabetes. Many advances have occurred that allow for long-term freedom from insulin and abrogation of the secondary complications of diabetes. However, pancreas allograft survival is dependant upon excellent technical success in the first month following transplantation. RECENT FINDINGS: It is clear that prevention of surgical complications has implications not only for graft and patient survival but also significantly impacts the financial impact following transplantation. Although complications can occur, early appropriate management can limit morbidity. In addition, when pancreas and kidney transplantation occur simultaneously, delayed treatment of pancreas complications can lead to kidney allograft loss. SUMMARY: This review concentrates on the diagnosis and management of early surgical complications following pancreas transplantation. The financial implications of surgical outcomes in pancreas transplantation are also discussed.

Nonaxisymmetric simulations of the Princeton magnetorotational instability experiment with insulating and conducting axial boundaries.

Stability and nonlinear evolution of rotating magnetohydrodynamic flows in the Princeton magnetorotational instability (MRI) experiment are examined using three-dimensional non-axisymmetric simulations. In particular, the effect of axial boundary conductivity on a free Stewartson-Shercliff layer (SSL) is numerically investigated using the spectral finite-element Maxwell and Navier Stokes (SFEMaNS) code. The free SSL is established by a sufficiently strong magnetic field imposed axially across the differentially rotating fluid with two rotating rings enforcing the boundary conditions. Numerical simulations show that the response of the bulk fluid flow is vastly different in the two different cases of insulating and conducting end caps. We find that, for the insulating end caps, there is a transition from stability to instability of a Kelvin-Helmholtz-like mode that saturates at an azimuthal mode number m=1, whereas for the conducting end caps, the reinforced coupling between the magnetic field and the bulk fluid generates a strong radially localized shear in the azimuthal velocity resulting in axisymmetric Rayleigh-like modes even at reduced thresholds for the axial magnetic field. For reference, three-dimensional nonaxisymmetric simulations have also been performed in the MRI unstable regime to compare the modal structures.

Metaanalysis of 68Ga-PSMA-11 PET Accuracy for the Detection of Prostate Cancer Validated by Histopathology.

68Ga-PSMA-11 PET is used to stage patients with prostate cancer. We performed an updated metaanalysis that separates imaging at the time of diagnosis and at the time of biochemical recurrence and focuses on pathology correlation in both populations. Methods: We searched the MEDLINE and EMBASE databases using the PRISMA statement. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool 2. In total, 1,811 studies were screened, 58 were analyzed, 41 were included for qualitative synthesis, and 29 were included for quantitative analysis. A random-effect model and a hierarchical summary receiver-operating-characteristic model were used to summarize the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy for pelvic lymph nodes in initial staging compared with pathology at prostatectomy and the PPV for lesions with pathologic correlation in those with biochemical recurrence. We also summarized the detection rate of 68Ga-PSMA-11 in those with biochemical recurrence stratified by prostate-specific antigen (PSA) at the time of imaging. Results: The metaanalysis of 68Ga-PSMA-11 at initial staging demonstrated a sensitivity and specificity of 0.74 (95% confidence interval [95% CI], 0.51-0.89) and 0.96 (95% CI, 0.85-0.99), respectively, using nodal pathology at prostatectomy as a gold standard. At biochemical recurrence, the PPV was 0.99 (95% CI, 0.96-1.00). The detection rate was 0.63 (95% CI, 0.55-0.70), with a PSA of less than 2.0 and 0.94 (95% CI, 0.91-0.96) with a PSA of more than 2.0. Conclusion:68Ga-PSMA-11 performed well for the localization of metastatic prostate cancer at initial staging and at the time of biochemical recurrence.

Clavicle Fracture Malunion Treated with an Osteotomy Guided by a Three-Dimensional-Printed Model: A Case Report.

CASE: This case report describes the management of a chronic and symptomatic clavicle malunion with use of a 3-dimensional (3D)-printed model during the preoperative surgical planning. CONCLUSION: The use of 3D printing has many applications in the medical field. Constant improvement in the quality of 3D printing has contributed to its increased use in a variety of surgeries. In our patient, 3D printing was used to generate a surface model of the clavicle fracture malunion and the "mirrored" contralateral healthy clavicle to plan an intraoperative osteotomy, which optimized the relative position of the osteotomy segments and hardware fixation.

Effects of axial boundary conductivity on a free Stewartson-Shercliff layer.

The effects of axial boundary conductivity on the formation and stability of a magnetized free Stewartson-Shercliff layer (SSL) in a short Taylor-Couette device are reported. As the axial field increases with insulating endcaps, hydrodynamic Kelvin-Helmholtz-type instabilities set in at the SSLs of the conducting fluid, resulting in a much reduced flow shear. With conducting endcaps, SSLs respond to an axial field weaker by the square root of the conductivity ratio of endcaps to fluid. Flow shear continuously builds up as the axial field increases despite the local violation of the Rayleigh criterion, leading to a large number of hydrodynamically unstable modes. Numerical simulations of both the mean flow and the instabilities are in agreement with the experimental results.

Clinical measurements versus patient-reported outcomes: analysis of the American Shoulder and Elbow Surgeons physician assessment in patients undergoing reverse total shoulder arthroplasty.

BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) score is composed of a patient-reported portion and a physician assessment. Although the patient-reported score is frequently used to assess postoperative outcomes after shoulder arthroplasty, no previous studies have used the physician-assessment component. This study evaluated the relationship of the ASES physician-assessment measurements with patient-reported shoulder and general health outcomes. METHODS: A retrospective review of a prospectively collected multicenter database was used to analyze patients who underwent primary reverse total shoulder arthroplasty (RTSA) from 2012 to 2015 with a minimum 2-year follow-up. ASES physician-assessment and patient-reported components and 12-Item Short Form Health Survey (SF-12) general health questionnaires were obtained preoperatively and 2 years postoperatively. The relationship between ASES physician measurements with ASES patient-reported outcome (PRO) scores and SF-12 Physical and Mental domain scores was assessed with Pearson correlation coefficients. RESULTS: Included were 74 patients (32 men; mean age, 69.2 years; body mass index, 29.4 kg/m2). Preoperative physician measurements and PRO scores were not significantly correlated. Postoperatively, only the ASES physician-measured active (R = 0.54, P < .01) and passive forward flexion (R = 0.53, P < .01) demonstrated moderate correlation with ASES patient scores. The remaining clinical measurements had no significant correlations with ASES patient or SF-12 scores. During the 2-year period, only improvements in active forward flexion correlated with improvements in ASES patient scores (R = 0.36, P < .01). CONCLUSIONS: Little correlation exists between clinical measurements from the ASES physician component and PROs, including the ASES patient-reported and SF-12 general health surveys, in RTSA patients. Improvement in active forward flexion is the only clinical measurement correlated with PRO improvement at 2 years.

Role of intra-islet endothelial cells in islet allo-immunity.

BACKGROUND: Intra-islet endothelial cells (IECs) express high levels of major histocompatibility complex (MHC) and are pivotal for posttransplant islet revascularization. We postulated that donor-specific sensitization would result in hyperacute rejection of IECs and prevent islet engraftment. Furthermore, ligation of endothelial cells with subsaturating concentrations of anti-MHC class I antibody (Ab) results in "accommodation" conferring protection against Ab/complement-mediated lysis. Therefore, we investigated whether accommodation of IECs would prevent hyperacute rejection of islets in sensitized recipients. METHODS: Islets were transplanted beneath the kidney capsule and allograft survival monitored using daily blood glucose (diabetes >300 mg/dL, normoglycemia <150 mg/dL). Recipients were presensitized with donor islets, splenocytes, or skin. Accommodation was induced by incubating human or murine islets with varying concentrations of anti-MHC class I Ab ex vivo. RESULTS: Isografts remained functional for >100 days, whereas allografts were rejected by day 14. Islet allo-transplantation induced donor-specific but not third-party anti-MHC Abs. Donor-specific, but not third-party, sensitization induced hyperacute rejection of subsequent islet allografts (median survival 1 day) associated with complement deposition. Preincubation of islets with subsaturating concentrations of anti-MHC-I Abs (1-100 ng/mL) up-regulated Bcl-2, Bcl-xl, and HO-1 within CD31+ IEC. These accommodated islets were resistant against hyperacute rejection when transplanted into donor-(splenocyte) sensitized recipients without any immunosuppression (median survival 6 days). CONCLUSIONS: Pretransplant sensitization against donor antigens results in hyperacute rejection of murine islets. IECs may play a crucial role in development of donor-specific immunity after islet transplantation. Significantly, accommodation of IEC may confer resistance to hyperacute rejection in sensitized recipients.

Traveling waves in a magnetized Taylor-Couette flow.

We investigate numerically a traveling wave pattern observed in experimental magnetized Taylor-Couette flow at low magnetic Reynolds number. By accurately modeling viscous and magnetic boundaries in all directions, we reproduce the experimentally measured wave patterns and their amplitudes. Contrary to previous claims, the waves are shown to be transiently amplified disturbances launched by viscous boundary layers, rather than globally unstable magnetorotational modes.

Helical magnetorotational instability in magnetized Taylor-Couette flow.

Hollerbach and Rüdiger have reported a new type of magnetorotational instability (MRI) in magnetized Taylor-Couette flow in the presence of combined axial and azimuthal magnetic fields. The salient advantage of this "helical" MRI (HMRI) is that marginal instability occurs at arbitrarily low magnetic Reynolds and Lundquist numbers, suggesting that HMRI might be easier to realize than standard MRI (axial field only), and that it might be relevant to cooler astrophysical disks, especially those around protostars, which may be quite resistive. We confirm previous results for marginal stability and calculate HMRI growth rates. We show that in the resistive limit, HMRI is a weakly destabilized inertial oscillation propagating in a unique direction along the axis. But we report other features of HMRI that make it less attractive for experiments and for resistive astrophysical disks. Large axial currents are required. More fundamentally, instability of highly resistive flow is peculiar to infinitely long or periodic cylinders: finite cylinders with insulating endcaps are shown to be stable in this limit, at least if viscosity is neglected. Also, Keplerian rotation profiles are stable in the resistive limit regardless of axial boundary conditions. Nevertheless, the addition of a toroidal field lowers thresholds for instability even in finite cylinders.